Cancer Causes & Control最新文献

Purpose: Cancer-related genes and pathways have recently been implicated in a genome-wide meta-analysis of head size. In the current study, we aimed to evaluate the association between adult head circumference and the risk of cancer.

Methods: This is a cohort study using data from the Hong Kong Osteoporosis Study, where 1,301 participants aged 27-96 years with head circumference measured between 2015 and 2019, and without a history of cancer, were followed up to 15 January 2024. Incident cancers were identified using electronic medical records from a territory-wide database. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression, adjusting for age, sex, height, weight, education, smoking, alcohol drinking, physical activity, and family history of cancer, as well as accounting for familial clustering.

Results: The median head circumference was 53 cm (interquartile range [IQR]: 51-54) and 54 cm (IQR: 53-55) for women and men, respectively. During a median follow-up of 6.9 years, 66 individuals were diagnosed with cancer. In the adjusted model, a larger head circumference was associated with an increased risk of any cancer (HR per cm increase: 1.17; 95% CI 1.00-1.36). Results remained similar when adjusting for waist-to-hip ratio instead of weight or when additionally adjusting for serum calcium and phosphorus levels. When stratified by cancer sites, head circumference was most strongly associated with colorectal cancer (HR per cm increase: 1.81; 95% CI 1.14-2.90) and prostate cancer (HR per cm increase: 1.58; 95% CI 1.16-2.16).

Conclusion: Head circumference is positively associated with the risk of cancer independently of height, weight, and other cancer risk factors.

Purpose: Urbanization has emerged as one of the main determinants of the rising breast cancer incidence in Asia, but understanding the link is hindered by the lack of population-based prospective cohorts, especially in low- and middle-income countries. Given that mammographic density (MD) is one of the strongest breast cancer risk factors and that it is associated with known lifestyle and reproductive factors, we explored using MD to delineate factors associated with differences in breast cancer risk between women living in urban and rural areas.

Methods: Using data from a cross-sectional study of 9,417 women living in urban or rural areas recruited through hospital- or community-based opportunistic mammography screening programs, we conducted regression and mediation analyses to identify factors contributing to the differences in MD between urban and rural populations across Asian ethnic subgroups.

Results: Consistent with higher risk of breast cancer, age-and-BMI-adjusted percent and absolute MD measurements were significantly higher in women living in urban areas compared to those in rural areas. Mediation analyses showed that differences observed were partly explained by higher parity (7-9%) and breastfeeding (2-3%) among women living in rural areas. Notably, the effect of parity (number of children) was similar in Chinese and Malay women (16-17% and 7-8%, respectively), but not observed in Indian women. Hormonal use, smoking, and physical activity did not predict MD nor mediate the observed association.

Conclusion: Higher MD among women living in urban compared to rural areas is partially attributable to parity and breastfeeding practices, a significant proportion of attributable risk remains unknown.

Breast cancer is the most highly reported cancer in India. Genetic testing could help tackle the increasing cancer burden by enabling carriers obtain early diagnosis through increased surveillance, and help guide treatment. However, accurate interpretation of variant pathogenicity must be established in a population-specific manner to ensure effective use of genetic testing. Here we query IndiGen data obtained from sequencing 1029 Indian individuals, and perform variant classification of all reported BRCA variants using gold-standard ACMG & AMP guidelines to establish disease epidemiology. To address the high number of VUS variants thus obtained, we further utilize the brca-NOVUS ML tool to obtain pathogenicity predictions in a manner close to ACMG guidelines at scale. Through the manual application of ACMG & AMP guidelines, we determined the genetic prevalence to be the following: 1 in 342 carriers of BRCA1, and 1 in 256 carriers of BRCA2 pathogenic/likely pathogenic variants bear a significant lifetime risk of developing breast / ovarian cancer in India. The high population prevalence and unique variant landscape emphasizes a need for population-scale studies of causative variants to enable effective screening. We advise cautious clinical interpretation, given incomplete penetrance and other complex factors that result in cancer disease. To the best of our knowledge, this is the first and most comprehensive population-scale genetic epidemiological study of BRCA-linked breast cancer variants reported from India.

Background: This study evaluates the implementation of the GETSET (Guiding Endocrine Therapy Success through Empowerment and Teamwork) pilot, a motivational interviewing (MI) intervention aimed at improving endocrine therapy (ET) adherence among patients with breast cancer.

Methods: Using the Consolidated Framework for Implementation Research (CFIR), qualitative interviews were conducted with site staff (N = 2), patients (N = 4), and counselors (N = 2).

Results: The thematic analysis identified facilitators such as high-quality materials, ease of scheduling sessions, and effective communication among staff. However, barriers included lack of personalization and systemic issues like understaffing.

Conclusions: The study underscores the need to adapt implementation of behavioral interventions in a healthcare setting to improve ET adherence. As this was a process evaluation of a pilot study, future work should evaluate the barriers and facilitators to a larger clinical trial to identify if the same strategies should be refined.

In January 2025, the United States Surgeon General issued an advisory describing the scientific evidence for the causal link between alcohol consumption and increased cancer risk. The report is timely as the link between alcohol and cancer is well established. Few would dispute the generally adverse effects of alcohol consumption on cancer risk and overall health with excessive levels of intake. More controversy exists at light-to-moderate levels of intake, such as not exceeding 2 drinks per day for men or 1 drink per day for women. Cancer risk may be the biggest concern in the low-moderate range of drinking as about one-quarter of cancer cases attributable to alcohol consumption arise in those consuming two or fewer alcoholic drinks daily. In moderate alcohol consumers, four modifying factors merit consideration, tobacco use, drinking frequency, whether drinking is with meals or on an empty stomach, and beverage type. Conclusions based simply on the overall dose-response without considering these factors is inadequate. A more thorough synthesis of the current literature and new studies and analyses designed to address these questions is imperative for developing practical recommendations for low-to-moderate alcohol drinking.

Purpose: Prospective cohort development in low-resource settings may be limited by cancer registry population coverage; however, information routinely collected in health systems may offer opportunities to advance cancer research. We aim to illustrate in a cohort study in Mexico, a cancer ascertainment strategy that integrates multiple sources of information including healthcare utilization databases.

Methods: The Mexican Teachers' Cohort (MTC) includes 114,545 female teachers aged 25 years and older who completed a baseline questionnaire between 2006 and 2010 and were breast cancer free. We used healthcare utilization databases (including electronic health records), self-reported breast cancer, mortality, and cancer registries to identify women with incident breast cancer. We estimated the positive predictive value for self-reported breast cancer and age-specific and age-standardized incidence rates for breast cancer and corresponding 95% confidence intervals (95%CI) calculating person-time from the date of baseline questionnaire response to diagnosis, death, or December 31, 2019.

Results: Between baseline and 2019, we identified 1,313 women with incident breast cancer. We established the diagnosis in 88% using healthcare utilization databases, 6% using cancer and mortality registries, and 6% directly by contacting participants. The positive predictive value of self-reported diagnosed and treated breast cancer was 94% (95%CI 91, 97). The age-standardized incidence was 77.0 per 100,000 person-years (95%CI 75.9, 84.3). The highest incidence was observed in women aged 65-69 years (185.3 per 100,000 person-years).

Conclusion: Leveraging healthcare utilization databases to establish cancer diagnoses within prospective cohorts may offer an opportunity to advance global cancer research.

Purpose: Breast cancer (BC) incidence is increasing in US women under 40, with variation across racial and ethnic groups. It is not yet known if incidence trends also vary by geography within the USA, which may inform whether place-based exposures contribute to BC risk in younger women.

Methods: Using the US Cancer Statistics database, we analyzed age-adjusted BC incidence rates from 2001 to 2020 in women aged 25-39. We calculated the average annual percent change (AAPC) using Joinpoint regression and performed age-period-cohort analyses.

Results: From 2001 to 2020, BC incidence in women under 40 increased by more than 0.50% per year in 21 states, while remaining stable or decreasing in the other states. Incidence was 32% higher in the five states with the highest rates compared to the five states with the lowest rates. The Western region had the highest rate of increase (AAPC = 0.76, 95% CI 0.56-0.96), despite having the lowest absolute incidence rate from 2001 to 2020. The Northeast had the highest absolute rate of BC among women under 40 and experienced a significant increase over time (AAPC = 0.59, 95% CI 0.36-0.82). The South was the only region where BC under 40 did not increase from 2001 to 2020.

Conclusion: These findings support that BC incidence trends in US women under 40 vary by geography, and the range of state-specific risks was comparable in magnitude to other risk measures, such as polygenic risk scores. This suggest that incorporating place-based factors alongside established risk factors into risk prediction may improve our ability to identify groups of younger women at higher risk for early-onset BC.

Purpose: There is increasing interest in the use of cannabis products to alleviate symptom burden among cancer patients. Although data remain limited, some evidence suggests that state legalization of cannabis is associated with reduced opioid use. Indices of area-level social determinants of health may provide insights into the patterns of symptom-managing behaviors in the context of health equity.

Methods: Residential ZIP codes from 854 Ohio residents diagnosed with invasive cancer at an academic cancer center were used to assign rural-urban commuting area (RUCA) codes and social deprivation index (SDI) values. RUCA was categorized as metropolitan and non-metropolitan, and SDI was dichotomized at the median. Participants completed a one-time cannabis-focused questionnaire which included items on medications used to alleviate symptoms.

Results: The prevalence of self-reported cannabis (19% vs. 13%) and opioid use (30% vs. 21%) were higher among patients living in areas of higher social disadvantage vs. lower. No differences were observed for use of benzodiazepines or for any product by residential urbanicity.

Conclusion: Larger, multi-institutional studies with detailed measurement of cannabis and medications and an increased capacity to examine additional social determinants of health are needed to confirm and explain these descriptive findings.

Purpose: Prolonged treatment delay often leads to adverse cancer prognosis. However, the demographic and clinical predictors of higher treatment delay burden in the Philippines have not been thoroughly evaluated.

Methods: We conducted a population-based retrospective cohort study on patients diagnosed with common cancers who received cancer treatment, to quantify the burden of prolonged treatment delay in the Philippines among this population. We analyzed 20,654 patients with common cancers from the Department of Health-Rizal Cancer Registry. The Poisson regression model with robust variance was used to identify demographic and clinical predictors of prolonged treatment delay. In addition, we examined the associations among those receiving different initial treatment types, including surgery, radiotherapy, and chemotherapy.

Results: We found 35.1 % of the studied cancer patients experienced initial treatment delay of more than 30 days, as well as 25.2 % and 20.0 % experiencing treatment delays exceeding 60 and 90 days, respectively. We found higher risk of prolonged treatment delay of more than 90 days in those with 0-19 years of age at diagnosis, male gender, cancer treatment at non-private hospitals, diagnoses during the 1990s, more advanced cancer stages, and non-surgical initial treatments. For patients with surgery as the initial treatment, younger age at cancer diagnosis was not significantly associated with increased burden of prolonged treatment delay, unlike for those initially treated with radiotherapy or chemotherapy.

Conclusion: By identifying the characteristics of treated cancer patients with higher risk of protracted treatment delay, our findings will inform the national cancer control program to especially target those patients for treatment delay reduction.

Background: Evidence on breast cancer survival and factors affecting survival is crucial for evaluating treatment effectiveness and formulating breast cancer control strategies. Although original research has been conducted on the survival rate of breast cancer patients and their determinants in Ethiopia, there is a shortage of comprehensive scientific evidence. The present study systematically reviewed literature on the survival rate of breast cancer patients and the predictors of survival in Ethiopia.

Methods: A comprehensive search was conducted in the PubMed, HINARI, Global Index Medicus, and Google Scholar databases up to August 26, 2024. Without any design restrictions, studies on breast cancer patients that measured survival at different time points in Ethiopia were included. The results are summarized in a table, the survival rates are pooled, and risk factors are narratively synthesized. To assess the risk of bias, the Newcastle Ottawa Scale was utilized. Heterogeneity between studies was assessed using the I² statistic. Potential publication bias was assessed using a funnel plot. To examine robustness, a leave-one-out sensitivity analysis was performed.

Results: The pooled survival rates in the first, second, third, fifth, and sixth years were 90%, 70%, 68%, 46%, and 44%, respectively. Advanced age, lower socioeconomic status, late clinical stage, delayed diagnosis, higher histological grade, metastasis, lymph node involvement, presence of comorbidity, tumor size, and estrogen receptor positive were factors that increased the risk of mortality in the included studies.

Conclusion: Survival rate of breast cancer patients in later time including fifth and sixth years was comparably lower than other countries. It is crucial to raise awareness about breast cancer screening, early diagnosis, and therapy initiation to increase the survival rate of breast cancer patients in Ethiopia. In addition, it is important to emphasize the risky population groups, which includes those with lower socioeconomic status and advanced clinical parameters.